Treatment of Rheumatic Heart Disease

Although medication cannot correct a defect in the aortic or mitral valve, certain drugs may be used to ease the symptoms of stenosis and insufficiency. However, the only way to eliminate the condition is to repair or replace the valve by surgery.

Medication

Patients may be prescribed diuretics anticoagulants to prevent blood clots from forming in the damaged heart. They may also be given diuretics to reduce the fluid that accumulates in the lungs or legs, which can accompany valve insuffuciency. Vasodilators such as ACE inhibitors, nifedipine, and hydralazine may be used to provide short-term benefit in aortic insufficiency, along with drugs to treat atrial fibrillation or other rhythm disturbances. High blood pressure exacerbates valve insuffuciency, and so medication to reduce the blood pressure may be used.

One of the great risks to patients suffering from valve damage is endocarditis - an infection of the heart's inner lining. This infection often attacks the heart valves, particularly if it's already damaged. Patients are therefore often advised to take antibiotics before dental or medical procedures that may increase the likelihood of bacteria entering the bloodstream and thus causing an infection.

Surgery

Surgery may be necessary to either replace faulty valves or repair them so that they work more efficiently.

1. Valve Repair

Aortic or mitral valve repair may be performed to save the valve and to improve its function. This may be carried out by modifying the original valve in a procedure known as valvuloplasty, which should help to eliminate backward blood flow. In mitral stenosis, the symptoms can be relieved by cutting the tight, stiff ring of valvular tissue.

2. Valve Replacement

Mitral and aortic valves may be replaced with either a mechanical valve or a tissue valve from a pig, cow or human cadaver donor. Mechanical valves are very durable, but can raise the risk of blood clots forming, which means that the patient would be required to take an anticoagulant medication, such as warfarin for life to prevent this from happening. Tissue valves do not carry this risk of clotting, but are much less durable than mechanical valves, so may need to be replaced at some point.

Valve replacement is currently an open-heart procedure, requiring the individual to be placed on a heart-lung machine that assumes their breathing and blood circulation function during the procedure.